Gender-Specific Outcomes after Percutaneous Left Atrial Appendage
Closure - A Nationwide Readmission Database Analysis
Background: Thromboembolism-associated stroke is the most feared
complication of Atrial fibrillation (AF). Percutaneous left atrial
appendage closure (pLAAC) is indicated for stroke prevention in patients
with AF who can’t tolerate long-term anticoagulation. We aim to study
gender differences in peri-procedural and readmissions outcomes in pLAAC
patients. Methods: Using the national readmission database from January
2016 to December 2018, AF patients undergoing the pLAAC procedure were
identified. We used multivariate logistic regression analyses and
time-to-event Cox regression analyses to conduct the study. Propensity
matching with the Greedy method was done for the accuracy of results.
Result: 28,819 patients were included in our study. Among them 11,946
(41.5%) were women and 16,873 (58.6%) were men. The mean age of
overall population was 76.1 ± 8.5 years, with women ~ 1
year older than men. The overall rate of complications was higher in
women (8.6% vs 6.6%, P<0.001), primarily driven by
bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI:
1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97,
p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014).
Women had two times higher peri-procedural ischemic stroke. There was no
difference in peri-procedural mortality. Women remained at 20% and 13%
higher risk for readmission at 30 days and 6 months of discharge.
Conclusion: Women had higher peri-procedural complications and were at
higher risk of readmissions at 30 days and six months. However, there
was no difference in mortality during the index hospitalization. Further
studies are necessary to determine causality.